Acta Oncologica最新文献

{"title":"Synchronous metastases from colorectal cancer. Treatment and long-term survival compared to patients with metachronous metastases: a population-based study from Central Norway 2001-2015.","authors":"Per Even Storli, Rachel Genne Dille-Amdam, Gaute Havik Skjerseth, Mads Vikhammer Gran, Tor Åge Myklebust, Jon Erik Grønbech, Erling A Bringeland","doi":"10.2340/1651-226X.2025.42985","DOIUrl":"10.2340/1651-226X.2025.42985","url":null,"abstract":"<p><strong>Background: </strong>Reliable and modern information on primary evaluation, treatment, and long-term survival rates for patients with colorectal cancer (CRC) metastases are needed. Whether synchronous CRC metastases carry a worse prognosis than metachronous is still debated.</p><p><strong>Methods: </strong>Population-based study on 7,950 CRC patients from Central Norway, 2001- 2015. Of these, 1,843 (23.2%) had synchronous metastases and of radically operated patients with stage I-III disease 1,117 (20.1%) developed metachronous metastases. The treatment strategies and outcomes for patients with metastases were analyzed, stratified by three consecutive 5-year periods.</p><p><strong>Results: </strong>Median and 3-year survival for patients with synchronous metastases were 11 months and 16.4%, compared to 17 months and 29.4% with metachronous metastases, p < 0.001 and p < 0.001, respectively. The subsets receiving supportive care only, had a median survival of 3-4 months. Patients with synchronous metastases and primary palliative chemotherapy had a median survival of 15 months compared to 18 months with metachronous metastases, p < 0.001. Neither groups improved survival across the study period. The 5-year survival for the 342/1,843 (18.6%) patients with synchronous metastases and curative intent treatment was 41.8% compared to 43.6% for the corresponding 422/1,117 (37.8%) patients with metachronous metastases, log-rank p = 0.281. Survival significantly improved for both these groups across the study period.</p><p><strong>Interpretation: </strong>A key determinant of better survival for patients with metachronous CRC metastases compared to synchronous was a significantly higher proportion treated with curative intent. Survival for both patients with synchronous and metachronous metastases taken collectively steadily improved during the study period, driven by the increased proportions and improved survival for the subsets with curative intent treatment.</p>","PeriodicalId":7110,"journal":{"name":"Acta Oncologica","volume":"64 ","pages":"797-806"},"PeriodicalIF":2.7,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discrepancies in regional lung cancer multidisciplinary team decisions can be reduced through national consensus meetings.","authors":"Anja Gouliaev, Weronika Maria Szejniuk, Joan Fledelius, Hans Henrik Torp Madsen, Rene Horsleben Petersen, Torben Riis Rasmussen","doi":"10.2340/1651-226X.2025.43314","DOIUrl":"10.2340/1651-226X.2025.43314","url":null,"abstract":"<p><strong>Background: </strong>Multidisciplinary team (MDT) meetings are a gold standard in lung cancer care. A recent study identified discrepancies in staging and treatment recommendations among Danish lung cancer MDTs based on fictitious cases. This short report presents the results from a national lung cancer MDT meeting, which reevaluated these difficult cases.</p><p><strong>Method: </strong>Fifteen difficult cases were reevaluated by 52 lung cancer specialists from across Denmark, representing oncology, pulmonology, radiology, nuclear medicine, and thoracic surgery. Participants were grouped together with their usual MDT colleagues. Cases were presented in a plenary session, and participants discussed cases staging, treatment intent, and treatment options as they would in a regular MDT with their colleagues. If disagreement between the individual MDT groups occurred, the case was further discussed in plenum. Descriptive statistics were used to assess agreement.</p><p><strong>Results: </strong>Complete agreement on tumor node metastasis (TNM) staging, treatment intent, and recommended treatment was reached in three cases (20%). Agreement on stage was reached in 10 cases (67%). Discrepancies regarding stage arose from debates regarding multifocal versus synchronous lung cancers, degree of lymph node involvement and the malignancy status of pleural fluid. Differences in treatment recommendations were mainly due to insufficient information about performance status.</p><p><strong>Interpretation: </strong>Staging and treatment intent discrepancies among Danish lung cancer MDTs were considerably reduced when complex cases were discussed in a national plenary session. However, for difficult lung cancer cases, MDTs recommend different treatment, highlighting the need for a national MDT meeting for a select group of lung cancer patients.</p>","PeriodicalId":7110,"journal":{"name":"Acta Oncologica","volume":"64 ","pages":"793-796"},"PeriodicalIF":2.7,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144309411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment and outcomes for locally recurrent rectal cancer in Norway.","authors":"Ghazwan Al Haidari, Arne M Solbakken, Linn Merete Åsli, Eva Skovlund, Christine Undseth, Marianne Grønlie Guren","doi":"10.2340/1651-226X.2025.42991","DOIUrl":"10.2340/1651-226X.2025.42991","url":null,"abstract":"<p><strong>Background: </strong>The rate of locally recurrent rectal cancer (LRRC) in Norway has decreased due to advancements in surgical techniques and preoperative treatments. Despite this, LRRC continues to present significant morbidity and mortality challenges. This study aims to analyze survival outcomes following different treatment modalities for LRRC in Norway and assess the impact of changes in treatment strategies over time.</p><p><strong>Methods: </strong>This retrospective study utilized data from the Cancer Registry of Norway, focusing on patients with stage I-III primary rectal cancer treated between 1997 and 2016, who subsequently developed LRRC. Treatment modalities, including surgery, radiotherapy (RT), and re-irradiation (reRT), were analyzed, and the impact of various factors on overall survival (OS) was assessed.</p><p><strong>Results: </strong>Of the 13,480 patients who underwent surgery for rectal cancer, 827 (6.1%) developed LRRC. For all patients, the median survival from LRRC diagnosis was 18 months, with a 3-year OS of 29%. For patients who underwent surgical resection of LRRC, the 3-year OS was 55% for those who received pre-operative RT, 50% for those who received reRT, and 35% for those without any radiation therapy. For non-operated patients, 3-year OS rates were 22% with RT, 21% with reRT, and 15% for patients without radiation therapy. Patients diagnosed after 2006, patients with early-stage primary cancer, younger age (<75), extended recurrence interval, or well-differentiated tumors had better survival outcomes.</p><p><strong>Interpretation: </strong>This study describes the outcomes after multimodal treatment approaches for LRRC on a national level over a 20-year period. Patients who underwent surgical resection combined with RT or reRT had the best survival outcomes; however, this group represents a highly selected patient population.</p>","PeriodicalId":7110,"journal":{"name":"Acta Oncologica","volume":"64 ","pages":"784-792"},"PeriodicalIF":2.7,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12175174/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144273932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lung cancer screening in Finland: a prospective randomized trial.","authors":"Viktor Wichmann, Sanna Iivanainen, Lauri Mattila, Veli-Pekka Kokkonen, Airi Jartti, Antti Kurtti, Riitta Kaarteenaho, Heidi Andersen, Antti Jekunen, Tuula Vasankari, Jussi Koivunen","doi":"10.2340/1651-226X.2025.43093","DOIUrl":"10.2340/1651-226X.2025.43093","url":null,"abstract":"<p><strong>Background: </strong>Early detection of lung cancer with low-dose computed tomography (LDCT) screening can shift diagnoses to early-stage disease and improve survival. However, LDCT has several challenges such as high false positive rate and indefinite cost-effectiveness. We report here secondary and exploratory endpoints of the Low-dose CT screening for lung cancer combined with different smoking cessation approach in Finland (LDCT-SC-FI) study including recruitment channels, LDCT performance, and long-term smoking cessation.</p><p><strong>Methods: </strong>In this study, we randomized 200 current smokers with a significant smoking history in 1:1 fashion to receive a smartphone application or standard of care written materials, both for smoking cessation. All underwent LDCT screening at baseline and at 1-year. Participants were recruited through multiple channels, including newspapers, internet advertisements, and healthcare referrals.</p><p><strong>Results: </strong>Newspaper advertisements were the most effective recruitment method, accounting for 74.5% of participants while minority came through referrals (2.5%). LDCT screening demonstrated uptake of 96.7% for both rounds combined. Six lung cancers were detected with a positive predictive value of 75%. Of the detected lung cancers, five were at stage I and all of these underwent curative intent treatment. Smoking cessation rates at 1-year were higher in the application (18.3%) than in the control arm (12.8%), though the difference was not statistically significant (odds ratio [OR]: 1.53, 95% confidence interval [CI]: 0.69-3.41).</p><p><strong>Interpretation: </strong>This study suggests that LDCT screening for lung cancer is feasible in Finland. The screening examination uptake was high with both screening rounds, while the positive predictive value for lung cancer detection remained at good level.</p>","PeriodicalId":7110,"journal":{"name":"Acta Oncologica","volume":"64 ","pages":"769-774"},"PeriodicalIF":2.7,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12171981/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144265036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of age and comorbidities on real-world outcomes in advanced breast cancer patients treated with palbociclib in first line: a nation-wide Danish retrospective study.","authors":"Alan Celik, Laurits Sebastian Dahl, Rasmus Garly, Vesna Glavicic, Maja Bendtsen Sharma, Sophie Yammeni, Humma Khan, Daniel Sloth Hauberg, Hanne Schultz Kapel, Ann Knoop, Tobias Berg","doi":"10.2340/1651-226X.2025.43226","DOIUrl":"10.2340/1651-226X.2025.43226","url":null,"abstract":"<p><strong>Background and purpose: </strong>Palbociclib, a cyclin-dependent kinase 4/6 (CDK4/6) inhibitor, combined with aromatase inhibitors (AI), can be used in first-line treatment for estrogen receptor (ER) positive, human epidermal growth factor receptor 2 (HER2) normal advanced breast cancer (ABC). This study aims to assess the impact of age and comorbidities on the progression-free survival (PFS) and overall survival (OS) of patients treated with palbociclib and AI.</p><p><strong>Materials and methods: </strong>This nationwide, retrospective cohort study included 604 women with ER positive, HER2 normal ABC treated with palbociclib and an AI between 2017 and 2021. Data were obtained from the Danish Breast Cancer Group database. Survival outcomes were analyzed based on age, Charlson Comorbidity Index (CCI), number of comorbidities, and comorbidity type. PFS and OS were estimated using the Kaplan-Meier method.</p><p><strong>Results: </strong>Median PFS for all patients was 30.6 months (95% confidence interval [CI], 27.4-34.2), and median OS was 55.6 months (95% CI, 51.8-58.9). Patients aged 65-75 years had significantly longer PFS and OS (p = 0.031 and p = 0.012) than patients aged under 65 and over 75 years. Visceral metastases were associated with shorter PFS and OS (p = 0.005). Comorbidity burden, including CCI score and comorbidity type, did not significantly affect survival outcomes.</p><p><strong>Interpretation: </strong>In our data set, univariate analyses suggest age and visceral metastases to be potential factors influencing outcomes in patients with ABC treated with palbociclib plus an AI. Comorbidities, did not significantly impact survival, suggesting that palbociclib is well-tolerated in patients with varying health profiles.</p><p><strong>Clinicaltrials: </strong>gov ID: NCT06307457.</p>","PeriodicalId":7110,"journal":{"name":"Acta Oncologica","volume":"64 ","pages":"778-783"},"PeriodicalIF":2.7,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12175173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144273930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The promises of precision medicine - voices from the Nordics.","authors":"Mef Nilbert","doi":"10.2340/1651-226X.2025.43987","DOIUrl":"10.2340/1651-226X.2025.43987","url":null,"abstract":"","PeriodicalId":7110,"journal":{"name":"Acta Oncologica","volume":"64 ","pages":"775-777"},"PeriodicalIF":2.7,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12175172/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144273931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world data on immune checkpoint inhibitors in advanced sarcomas across multiple European institutions.","authors":"Stefania Kokkali, Ana Dolcan, Kjetil Boye, Anastasios Kyriazoglou, Ioannis Boukovinas, Foteini Kalofonou, Anna Koumarianou, Natalia Asimakopoulou, Eleftherios Vorrias, Konstantinos Tsapakidis, Eleni Georgaki, Anna Boulouta, Leonidas Mavroeidis, Magnus Harneshaug, Stamatios Theocharis, Robin L Jones, Antonia Digklia","doi":"10.2340/1651-226X.2025.43135","DOIUrl":"10.2340/1651-226X.2025.43135","url":null,"abstract":"<p><strong>Background: </strong>Following the success of immune checkpoint inhibitors (ICI) in other cancer types, their role is being evaluated in sarcomas. They have been assessed as monotherapy, or in combination with other ICI, chemotherapeutic drugs and tyrosine kinase inhibitors (TKI) in several clinical trials. So far the results have been limited to non-selected sarcoma populations. Further work is required to select patients who will benefit from immunotherapy.</p><p><strong>Patients and methods: </strong>We conducted a pooled retrospective analysis of the use of ICI in patients with advanced sarcomas in multiple European institutions. ICI-based treatments included ICI monotherapy (n = 43, 59.7%), double ICI (n = 5, 6.9%), ICI plus TKI (n = 21, 29.2%) and ICI plus chemotherapy (n = 3, 4.2%).</p><p><strong>Results: </strong>Seventy-two patients from 10 European institutions, with metastatic (87.5%) or locally advanced (12.5%) disease were included. The most common subtype was undifferentiated pleomorphic sarcoma (16.7%), followed by leiomyosarcoma (12%), liposarcoma (10%) and angiosarcoma (9.7%). The median number of prior lines of systemic therapy was 2 (0-8). The objective response rate was 34.4% and was higher in combination regimens versus ICI monotherapy. With a median follow-up of 20.7 months, median progression-free survival (PFS) was 4.6 and median overall survival (OS) 18.8 months. Line of therapy (1st/2nd vs. ≥ 3rd line) and best response to ICI was significantly associated with PFS and OS. Histological subtype was significantly associated with OS. Toxicity was in general manageable; only six (8.3%) patients discontinued therapy for AE.</p><p><strong>Interpretation: </strong>Our study provided additional real-world data on the outcome of ICI in patients with advanced sarcomas.</p>","PeriodicalId":7110,"journal":{"name":"Acta Oncologica","volume":"64 ","pages":"761-768"},"PeriodicalIF":2.7,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12171866/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144265037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"TCHL - a phase II neo-adjuvant study assessing TCH (docetaxel, carboplatin and trastuzumab) and TCHL (docetaxel, carboplatin, trastuzumab and lapatinib) in HER-2 positive breast cancer patients: a 5-year follow-up with serum biomarker analysis.","authors":"John Crown, Alex J Eustace, Denis M Collins, Maccon Keane, Linda Coate, John Kennedy, Seamus O'Reilly, Catherine Kelly, Miriam O'Connor, Michael Martin, Conleth Murphy, Karen Duffy, Janice Walshe, Giuseppe Gullo, Thamir Mahgoub, Alberto Alvarez-Iglesias, Imelda Parker, Vicky Donachie, Ausra Teiserskiene, Stephen F Madden, Brian Moulton, Norma O'Donovan, Bryan T Hennessy","doi":"10.2340/1651-226X.2025.43143","DOIUrl":"10.2340/1651-226X.2025.43143","url":null,"abstract":"<p><strong>Background: </strong>The docetaxel (T), carboplatin (C) and trastuzumab (H) regimen has been used in the (neo-) adjuvant treatment of HER2+ early stage breast cancer (ESBC). Lapatinib (L) a small molecule HER2 antagonist produces clinical responses following H failure.</p><p><strong>Methods: </strong>We randomly assigned 88 patients with stages Ic-III HER2+ESBC to receive neoadjuvant TCH, TCL or TCHL followed by surgery and 1 year of H. The primary endpoint was pathological complete response (pCR). Secondary objectives were overall and disease-free survival (OS, DFS).</p><p><strong>Results: </strong>The TCL arm was closed following demonstration of inferiority of L in another trial. The pCR rates for TCH and TCHL were 52.8 and 51.6 (p = 1.0). At a median 4.8 years follow-up, TCHL patients had a significantly superior DFS; however, OS was similar. Prophylactic loperamide reduced the frequency of diarrhoea. Serum biomarker analysis identified a link between high tumour T-cell levels and high red blood cell, haematocrit, and haemoglobin following commencement of therapy.</p><p><strong>Interpretation: </strong>The study did not meet its primary endpoint of superior pCR. TCHL produced a significant improvement in DFS. Our study and others suggest a possible role for L in neoadjuvant therapy of HER2+ ESBC.</p><p><strong>Clinical trial registration: </strong>NCT01485926.</p>","PeriodicalId":7110,"journal":{"name":"Acta Oncologica","volume":"64 ","pages":"751-760"},"PeriodicalIF":2.7,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12171739/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144223953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative study of lung cancer care and survival outcomes across the Nordic countries.","authors":"Ghida Khalife, Juho Waris, Uffe Bødtger, Johan Isaksson, Kirill Neumann, Hrönn Harðardóttir, Heidi Andersén, Antti Jekunen, Maria Lovén, Tuula Vasankari, Susanna Nurmi-Rantala, Paulus Torkki","doi":"10.2340/1651-226X.2025.42778","DOIUrl":"10.2340/1651-226X.2025.42778","url":null,"abstract":"<p><strong>Background: </strong>Lung cancer (LC) is the leading cause of cancer-related deaths worldwide. Despite societal, economic and genetic similarities, 5-year age-standardized relative survival rate is lower in Finland compared to the other Nordic countries. Previous studies have identified discrepancies in LC guidelines, but research on actual care practices remains limited. We aim to address this knowledge gap by conducting a comprehensive examination of the current care practices for LC patients in the Nordic countries.</p><p><strong>Methods: </strong>We employed a non-interventional, prospective study design. We conducted an expert workshop involving LC specialists from Finland to formulate relevant questions for a structured survey. This survey was distributed to healthcare professionals (HCPs) across Nordic hospitals and primary care units. The survey results were then analyzed, and a follow-up Nordic LC expert workshop was held to identify the most relevant factors potentially influencing LC survival outcomes.</p><p><strong>Results: </strong>Four key differences in care practices between Finland and other Nordic countries were identified: (1) resources available in primary care units, (2) waiting times in primary care, (3) availability of novel treatments and (4) tracking of LC survival and mortality outcomes by the hospital. Finland has the lowest access to computed tomography (CT) from primary care, longest waiting times in primary care, and lacks a national outcome tracking system. Some medical doctors in Finland and Iceland highlighted observed limitations in specific cases involving access to neoadjuvant immunotherapy and chemotherapy.</p><p><strong>Interpretation: </strong>Several factors unrelated to specialized LC care are likely contributing to poorer 5-year survival rates for LC in Finland. These findings may be applicable to other healthcare systems as well.</p>","PeriodicalId":7110,"journal":{"name":"Acta Oncologica","volume":"64 ","pages":"734-741"},"PeriodicalIF":2.7,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12160590/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144223951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility and outcome of genomics-guided treatment selection in advanced cancer - the MEGALiT explorative clinical trial.","authors":"Lars Ny, Henrik Fagman, Johan Botling, Loviisa Mantovaara, Peter Asplund, Hannah Karlsson, Jennie Aust, Edvard Abel, Mats Hellström, Joakim Crona, Peter Nygren","doi":"10.2340/1651-226X.2025.43366","DOIUrl":"10.2340/1651-226X.2025.43366","url":null,"abstract":"<p><strong>Background: </strong>Precision cancer medicine (PCM) is key to advancing cancer treatment beyond the standard of care. We performed an explorative clinical trial, MEGALiT, to investigate the feasibility, safety, and clinical benefit of genomics-based PCM in advanced cancer.</p><p><strong>Methods: </strong>MEGALiT recruited adult patients with advanced solid tumors refractory to standard treatment. Tumor DNA from newly acquired biopsies or ctDNA were analyzed for alterations targetable with the PD-L1 inhibitor atezolizumab, the MEK inhibitor cobimetinib, the mTOR inhibitor everolimus, or the PARP-inhibitor niraparib. Any other 'in study' treatment was left to the discretion of the physician.</p><p><strong>Results: </strong>Outcome data are reported for 153 patients. The median age was 65 years and the most common diagnoses were colorectal, prostate, and ovarian cancer. The median time from study inclusion to the Molecular Tumor Board was 35 days for tumor sampling by biopsy and 21 days by ctDNA. Of the 44 patients allocated to a study drug, 38 started treatment. The median follow-up was 1.9 years. Of the patients on a study drug and evaluable for tumor response, 6% (2/32) had partial remission, and 25% (8/32) had disease control at 16 weeks. Median overall survival for patients starting a study drug was longer, 7.4 months, compared to 2.7 months for the 61 untreated patients (HR 0.43; log-rank p < 0.0001), but shorter than for the 50 patients receiving treatment of physician's choice, 11.8 months (HR 0.55; log-rank p = 0.012). No significant procedure- or drug-related severe adverse events were observed.</p><p><strong>Interpretation: </strong>Genomics-guided treatment selection in advanced cancer is feasible and safe. However, evidence of patient benefit warrants further investigation.</p>","PeriodicalId":7110,"journal":{"name":"Acta Oncologica","volume":"64 ","pages":"742-750"},"PeriodicalIF":2.7,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12160592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144223952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}